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The International Decision Support Initiative (iDSI) is a global network of health, policy, and economic expertise working to achieve Universal Health Coverage. The initiative works with countries to support better decision-making on how public money for health can be spent more efficiently, effectively, equitably, and sustainably. This can help ensure fairer access to the right healthcare, treatment, and medicines at the right time. The iDSI secretariat is based at the Center for Global Development.
From outbreak preparedness spending to building better health technology assessment (HTA) capacity, iDSI and CGD’s work helps governments to make better decisions for better health.
Decisions about which type of patients receive what interventions, when, and at what cost often result from ad hoc, nontransparent processes driven more by inertia and interest groups than by science, ethics, and the public interest. Reallocating a portion of public and donor monies toward the most cost-effective health interventions would save more lives and promote health equity.
With aid budgets shrinking and even low-income countries increasingly faced with cofinancing requirements, this is the right time for global health funders such as the Global Fund and their donors to formally introduce Health Technology Assessment (HTA), both at the central operations level and at the national or regional level in recipient countries. In this CGD Note, we explain why introducing HTA is a good idea. Specifically, we outline six benefits that the application of HTA could bring to the Global Fund, the countries it supports, and the broader global health community.
India has fallen behind in both health expenditure and health outcomes compared to other lower-middle-income countries. Its burdens of tuberculosis and malaria, and increasingly noncommunicable diseases like diabetes, are one of the largest. Infant mortality and child malnutrition rates rival those in sub-Saharan Africa.
Universal health coverage (UHC) is now firmly on the global health agenda, and carries with it the ambitious goal of providing “access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost.” So where do we start? A critical first step to delivering on the aspirations of UHC is deciding which services and policies to prioritize and make available. While resources for health care are growing, they are not infinite and hard choices must be made.
The New England Journal of Medicine recently published the results of “the Oregon experiment” based on the 2008 US Medicaid program expansion in Oregon. The study is one of very few randomized control trials on publicly-subsidized health insurance that exists to guide health policy, and found what some commentators considered a disappointing result: while health care utilization increased and households were protected from financial hardship, expanding Medicaid coverage had “no significant impact on measured physical health outcomes over a 2-year period.”